Incidence of hearing loss
The NZ Health Survey carried out in 1991/92 showed that 9.8% of people reported
having hearing loss. This survey did not include institutionalised people, many
of whom would have hearing loss - so probably a more realistic figure is 10.5%.
There is a gender difference, with 12.3% of men, and 7.3% of women reporting
hearing loss. The prevalence of hearing loss as a function of age and gender is
shown in Figure 1.

Funding Schemes
There are six schemes under which hearing impaired people may receive
financial assistance towards the cost of their hearing aids:

The Special Aid Fund which purchases hearing aids for hearing impaired and
deaf children throughout New Zealand

The NZISS scheme which pays for hearing aids for a very select group of
people - usually those who are least in need of financial assistance (those in
employment, or in training). This scheme is due to pass to Vote:Health in July
1995, but little change is seen in terms of eligibility. This scheme is
designed for physically disabled people, but its eligibility criteria are not
very appropriate for hearing impaired people, the vast bulk of whom are
elderly, and therefore not in paid employment.

The ACC scheme which pays for hearing aids for people whose hearing loss
was caused by noise exposure or by accident. Most people eligible for
assistance under this scheme are men.

The War Pensions scheme which purchases hearing aids for people whose
hearing loss was caused (at least initially) during war service. Again, most
people qualifying for assistance under this scheme are men.

Some medical insurance schemes. Normally a higher level of premium is
required for cover including a contribution towards the cost of hearing aids.

The hearing aid subsidy for adults, which is a flat payment of $89.10 per
hearing aid.

NOTE: the hearing aid subsidy was increased to $198 per hearing aid in
2003

Hearing aid subsidy
The hearing aid subsidy originally covered the total cost of a locally produced
hearing aid and earmould, but over time it has not kept up with inflation, and
now is only a small contribution towards the cost of hearing aids (see Table 1).

Table 1. The value of the hearing aid subsidy over the years since its
inception, and its buying power

Year

Subsidy

H/Aid cost

Earmould cost

% covered

1947

£12 + 1 earmould

£12

£1

100%

1974

$45

1978

$70

1982

$81

$150-550

$20-40

16-59%

1988

$89.10

$200-720

$20-40

12-44%

1995

$89.10

$350-3000

$25-40

3-25%

Many people with hearing loss, who are ineligible for assistance from any of
the total payment schemes, are denied the help that hearing aids provide because
of the financial barrier. In Auckland public hospital clinics, about 35% of
adults assessed as needing hearing aids do not proceed to hearing aid fitting.

A positive change in the buying power of the subsidy as been the changes to
Health funding of equipment for disabled people to bring them into line with the
NZISS scheme. This has resulted in Accredited Equipment Assessors (in the
hearing area, these are audiologists) being authorized to approve hearing aid
subsidies. This has removed the need for assessment by an otologist, with a
consequent reduction in waiting time and/or cost.

Hearing impaired people are more likely to be in financial need than those
with normal hearing. Even with adjustments for population age differences (which
would be expected to increase the differences even more), 42% of people with
hearing loss have Community Services Cards, compared with 31% of people with no
hearing loss (NZ Health Survey).

In other countries, there is much more generous provision of state assistance
towards the purchase of hearing aids for elderly people. For example, in
Australia, the age level for state provision of hearing aids has recently been
decreased from 65 to 60 years. In New Zealand, the only population given total
coverage is children. The elderly receive a very poor level of support from the
taxpayer. Table 2 shows the actual expenditure on the hearing aid subsidy in
1991.

Table 2. Subsidy expenditure in four main centres of New Zealand (1991)

Area

Subsidy $

Subsidy #

Population 65+

Person/subsidy

Auckland

274,000

3,100

99,000

31.9

Wellington

107,000

1,200

39,000

32.5

Canterbury

90,200

1,000

55,600

55.6

Otago

40,000

450

21,350

47.4

4 centres

511,200

5,750

214,950

37.3

National estimate

798,750

8,984

335,860

37.4

A comparison of funding for hearing aids for children and elderly hearing
impaired (ignoring the NZISS, ACC and War Pensions schemes) for the northern
part of the country shows a major inequity. The results are shown in Table 3.

Table 3. State funding for elderly adults and children in the northern part
of New Zealand

Hearing impaired/deaf

Funding

Subsidy/hearing impaired person

Elderly (65+)

30,710

$290,000

$ 9.44

Children

625

$290,000

$464.00

Apart from the issues of the level of financial assistance provided by the
subsidy limiting access to assistance, there are also some concerns regarding
the provision of the hearing aid subsidy. With the repeal of the Hearing Aid
Regulations, health funders are bound to purchase hearing aid subsidies.
However, because of the complexity of the health system, in some cases the
subsidy has been withdrawn (eg in Canterbury), and only after protest has it
been reinstated. While it is possible that the Health and Disability
Commissioner could act as a watchdog, a high level of consumer awareness is
necessary to retain what ought to be a citizen's right (and has been under the
Regulations for nearly 40 years.

Another facet of the repealed Hearing Aid Regulations which is not being well
controlled by health funders is the need for hearing aids to be tested and
approved. Testing is carried out by the National Audiology Centre on a
cost-recovery basis, for hearing aid importers. All reputable importers are
currently happy to have their devices tested by the Centre, but there is
currently nothing to stop an unscrupulous operator from dumping sub-standard
equipment on the market. A recent case has seen exactly this done, using direct
mail selling of a useless and unsafe product.